Induction at 41 weeks and 1 day(s)

Archived User

Induction at 41 weeks and 1 day(s)

March 11, 2010 03:37 PM

I am a first time mom-to-be
and have a scheduled induction this Sunday March 14th at
6:30pm; I will be exactly 41 weeks and 1 day. I have had a flawless
pregnancy, my weight gain has been average, 29lbs to date, good
fetal movement, baby has always had a strong/clear heartbeat, and I
have remained active throughout my entire pregnancy, exercising at
least 4 days a week (in fact I walked 3 miles the day after my
“due date” which was March 6th). As of this past Monday
(March 8th) I was checked for dilation/effacement and my OB
informed me that my cervix was completely closed, and then
proceeded to schedule my induction at the hospital for this Sunday
with little else to say. I have been doing much reading/research on
the internet concerning inductions etc., and am not sure if I
should go through with this scheduled induction on Sunday. I called
my OB and made an appointment for tomorrow morning at 9am at which
time I will ask him to check me for dilation again. At this point I
am leaning heavily towards cancelling the induction if I have still
made no progress. My intent and desire for this pregnancy has
always been to have her naturally without an epidural. My question
is: should I go forward with the induction or wait a few more days,
perhaps ask them to schedule my induction closer to my 42 week?
Also, how do you feel about inducing a woman, who is not dilated or
effaced, especially a first timer? Thank you in advance for your
response!

Henci Goer

(FYI: myerstab07 e-mailed me on the side. I responded to her
e-mail because she was so short of time and asked that she post her
query to the Forum so that others who might be interested could
read my response. Having done that, I didn't feel the need to
rush to respond online.)

I cannot tell you what to do, of course, but I can tell you what
the research says: as a first-time mom with a cervix not ready for
labor, your chances of labor ending in a cesarean are at least
double what they would be if labor started on its own. Cervical
ripening agents do not change this fact. As for the rationale for
inducing at 41 weeks, this largely comes from an extremely flawed
study. You may wish to read
my critique of it.

Even if you refuse the induction, though, you are not out of
the woods. Insisting on going into labor in your own time may
result in your being subjected to scare tactics to get you to
change your mind, and that if you persist, once labor begins, you
may be depending on the judgment of a doctor who thinks continuing
the pregnancy beyond 41 weeks is risky and who therefore will be
overly anxious and who also thinks that you are a difficult
patient who cannot be trusted to do what is best. The best I
can tell you here is to see how your dr reacts. If the dr takes
this tack, the best advice I can give is to make sure that,
barring an emergency, any consent you give to medical
intervention or cesarean is based on factual information about
its benefits, potential harms, and the benefits and harms
of your alternatives, including doing nothing. Enlist your
labor support companion or companions to help you do this because
once in labor, you will be both vulnerable and
preoccupied.

-- Henci

Archived User

I wanted to
thank you for the advice, and for the warning of my doctor using
“scare tactics” to get me to keep the scheduled
induction date for this Sunday. They absolutely tried to scare me
into having this baby on Sunday, if they told me once, they said it
50 times, that I am running the risk of having a dead
baby…YES, they actually used those exact words! I was so
insulted, frustrated and ALMOST speechless.

What
is most interesting to me is that they confirmed what I had read,
that inducing, especially in a first time mom; with little to no
dilation/effacement does in fact double my odds of a c-section and
other medical interventions. However, they followed up with
“what would you rather have, a c-section with a live health
baby, or a dead baby, because it would be awful to come this far
and have your baby not survive”. At first they tried to tell
me that they would not push back my scheduled induction, however I
explained that I was adamant on rescheduling it for late next week,
when I am 42 weeks, and was willing to sign a release form if
needed. Once they could tell I was not backing down and their scare
tactics would not work on me, they acquiesced and rescheduled my
induction for late next week, but not before saying “fine the
decision is yours but be prepared for a dead baby”. I am
OUTRAGED with the treatment I have received, and will absolutely
begin looking for another practice as soon as I safely deliver my
healthy LIVE baby girl.

My baby is
thriving; she is active and has a strong heartbeat. I am going for
an ultrasound tomorrow morning to ensure that everything is going
well, which I am confident will be the case. I do understand that
my doctor has to look out for his practice and for the well being
of my baby, but I do not believe that threatening me with a
“dead baby” so that I will follow through with being
induced when they want, not when my body and baby are ready, shows
no regard for my body or my desires for the birth of my child.

Thankfully I
have a very strong labor support group, consisting of my husband,
my mother and mother-in-law who will be with me every step of this
journey. They all know what I want from my birth experience, and
will do what is necessary to make sure it happens. In hindsight I
wish I would have chosen a birth center or another practice that is
more in line with my pregnancy/birth wants and needs. Fortunately
we plan to have more children, and I will get to make the necessary
change for my next child!

Archived User

As an OB nurse for 10 years and then a Home Birth midwife for 10
years I will warn you about your ultrasound tomorrow. It's
another strong-arm technique to get you to have the induction and
then the doctor wins the power struggle. A common finding at
this gestation is low amniotic fluid. Drink a lot of water
tonight to help. The doctor will tell you it's a sign of a poorly
functioning placenta and a sign the baby has to be born. I
don't know for sure why this is a common finding at this point in a
healthy pregnancy (but in 10 years I saw a lot of healthy babies
born with lots of amniotic fluid after induction for low amniotic
fluid). My guess is that the baby is so big that the
ultrasound is unable to find all the amniotic fluid (behind the
baby) to measure and it erroneously tells you it is low.
Henci has some good information about that on this
site. Another part of the ultrasound that gives you
false results is the biophysical profile. Something that
measures the baby's well-being. Many women have been induced
for not having the required 8 out of 8 score. This is just
not a reliable test. Do some homework tonight and have
some information with you to discuss these issues with your
doctor. P.S. It is so heartwarming for me to see a
strong woman standing up for her helpless baby. When I worked
in the hospital I just rarely saw this. Stay strong!
Also, meditate on love & kindness for your baby's sake.
It's sad that a woman has to gear up as if she is fighting a war in
the days before her baby's birth.

Henci Goer

I'm sorry that you are in this difficult position. It looks like
you are doing a great job at protecting yourself the best you can.
I have one additional suggestion: when you arrive on L&D ,
ask to be assigned the nurse who is most comfortable with
and supportive of women who want to avoid medical intervention
whenever possible and who want their nurse to help
them make informed decisions about their care by
explaining their options, answering questions, and helping
them advocate for themselves if necessary. Repeat the request at
each shift change.

I would add too that the irony of their pushing you to risk
an unnecessary cesarean for the baby's sake in this pregnancy
exposes the babies of any future pregnancies and you as well to
threats that are equally, if not more, potent.

Please let me know how everything turns out. And if you do end
up agreeing to an induction at some point, search the Forum for
posts on induction. Many of them have advice on how to maximize
safety and likelihood of vaginal birth.